title: Nutritional status predicts preterm death in older people: a prospective cohort study.
abstract: OBJECTIVE
  There is an association between malnutrition and mortality. However, it is uncertain whether this association is independent of confounders. The aim of the present study was to examine whether nutritional status, defined according to the three categories in the full Mini Nutritional Assessment (MNA) instrument, is an independent predictor of preterm death in people 65 years and older.
  
  
  METHODS
  This prospective cohort study included individuals aged ≥65 years who were admitted to hospital between March 2008 and May 2009 and followed-up after 50 months (n = 1767). Nutritional status was assessed with the MNA, and possible risk factors associated with malnutrition were recorded during participants hospital stay. Main outcome measure was overall survival.
  
  
  RESULTS
  Based on the MNA definitions, 628 (35.5%) were well-nourished, 973 (55.1%) were at risk of malnutrition, and 166 (9.4%) of the participants were malnourished at baseline. During the follow-up period 655 (37.1%) participants died. At follow-up, the survival rates were 75.2% for well-nourished participants, 60.0% for those at risk of malnutrition, and 33.7% for malnourished participants (p < 0.001). After adjusting for confounders the hazard ratios (95% CI) for all-cause mortality were 1.56 (1.18-2.07) in the group at risk of malnutrition and 3.71 (2.28-6.04) in the malnourished group.
  
  
  CONCLUSIONS
  Nutritional status defined according to the three categories in the full MNA independently predicts preterm death in people aged 65 years and older. These findings are clinically important and emphasise the usefulness of the MNA for screening of nutritional status.
authors.affiliation: Centre for Clinical Research, Uppsala University, County Council of Västmanland, Västmanland County Hospital, 721 89 Västerås, Sweden; Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala Science Park, 751 85, Uppsala, Sweden. Electronic address: lisa.soderstrom@ltv.se.
authors.forename: Lisa
authors.initials: L
authors.lastname: Söderström
authors.affiliation: Centre for Clinical Research, Uppsala University, County Council of Västmanland, Västmanland County Hospital, 721 89 Västerås, Sweden. Electronic address: andreas.rosenblad@ltv.se.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rosenblad
authors.affiliation: Centre for Clinical Research, Uppsala University, County Council of Västmanland, Västmanland County Hospital, 721 89 Västerås, Sweden. Electronic address: eva.thors-adolfsson@ltv.se.
authors.forename: Eva Thors
authors.initials: ET
authors.lastname: Adolfsson
authors.affiliation: Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala Science Park, 751 85, Uppsala, Sweden. Electronic address: anja.saletti@pubcare.uu.se.
authors.forename: Anja
authors.initials: A
authors.lastname: Saletti
authors.affiliation: Centre for Clinical Research, Uppsala University, County Council of Västmanland, Västmanland County Hospital, 721 89 Västerås, Sweden; Department of Surgery, Västmanland County Hospital, 721 89 Västerås, Sweden. Electronic address: leif.bergkvist@ltv.se.
authors.forename: Leif
authors.initials: L
authors.lastname: Bergkvist
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000401:mortality*; D015596:Nutrition Assessment; D009752:Nutritional Status; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Malnutrition; Mini nutritional assessment; Nutritional status; Survival analysis